For references to the studies discussed in this info sheet, see the reference list.
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What is MDMA?
MDMA1 is a psychoactive (mind-altering) drug that affects how we think and behave. Ecstasy and molly are common names for the drug. MDMA is a stimulant that speeds up our breathing, heart rate, thoughts and actions. But it also is sometimes considered a hallucinogen since it can alter our senses and perceptions.
MDMA was first synthesized in 1912 by a pharmaceutical company while developing a drug to control bleeding. Today it is manufactured in uncontrolled laboratories and there is no way to know what’s mixed in it. It comes in the form of tablets, capsules or powder. It is usually swallowed but sometimes is snorted (e.g., sniffed through a straw) or injected.
Why do we use MDMA?
For several decades, people have been using MDMA for various reasons. Before MDMA was classified as an illegal substance, some psychotherapists experimented with the drug as a tool to help people explore their emotions. Today, some people continue to use the drug for emotional insight. Others use the drug to heighten their feelings of affection and empathy and connect with others. Still others use MDMA to have fun and stay active during a night out or at a party. But like any drug, MDMA can be harmful.
Many people choose not to use MDMA or to use the drug in moderation, because being less in control of their behaviour increases the likelihood of making unwise choices such as having unsafe sex. (Only about 6% of BC residents have tried MDMA, but in certain populations such as urban club-goers, use is more common.) Using MDMA may help us feel more outgoing at a party, but repeatedly using the drug to address social anxiety may lead to harms to our health or relationships.
What happens when we use MDMA?
When swallowed, MDMA is absorbed into the bloodstream through the small intestine and stomach. When snorted, the drug is absorbed into the bloodstream through the membranes in the nose, and when injected, it goes directly into the bloodstream. Once in the bloodstream, MDMA travels to the brain.
MDMA increases the release of naturally occurring chemicals in our brain that play a role in regulating our mood and energy level. We may feel energetic and exhilarated, peaceful and loving. But the effects of MDMA can be different for different people. Instead of feeling happy and content, some of us may feel anxious or nervous. Some of the factors that can influence how MDMA will affect us include our
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past experiences with the drug,
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present mood and surroundings, and
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mental and physical health condition.
Impact on well-being
MDMA use can have positive effects but it can also be harmful to our well-being. For instance, many people who use MDMA say it helps them dance for a long time. But combining MDMA with dancing in a hot room may lead to a dangerous increase in body temperature and loss of body fluid. The consequences can be life-threatening and include cardiovascular, kidney and liver impairment. And since it is not possible to know the purity and content of the drug, we can accidentally use too much or ingest another dangerous substance.
Using MDMA can also be both beneficial and harmful to our social lives. Small amounts of MDMA may help us feel more confident and outgoing when socializing. But increased openness and affection may lead us to take risks such as having unprotected sex. And using more than moderate amounts can make us feel anxious, affecting our interactions with others.
Studies on the effects of MDMA over time are inconclusive. MDMA use is associated with negative effects on memory. But some researchers suggest the impact may be minimal. Research suggests a link between MDMA use and depression. But it is not clear how much of the association is based on MDMA and how much is due to other factors such as vulnerability to depression.
Signs of acute adverse effects
It is important to take breaks from dancing, rest in a cool room and drink moderate amounts of water (an upper level of 500 ml per hour).
Signs of overheating and dehydration include a strong, rapid pulse, lack of sweating, dry flushed skin, faintness, staggering, confusion and coma.
Signs of diluted sodium levels (from drinking too much water) include nausea, headache, confusion, fatigue, restlessness and irritability, muscle weakness, spasms or cramps, seizures and coma.
If someone you know shows signs of adverse effects, call 911 right away. Remain with the person and try to get them to a cool place. If the person is conscious, try to keep them awake. If the person is unconscious, roll them onto their side into the recovery position so they won’t choke if they throw up.
When is using MDMA a problem?
Using MDMA is a problem when it negatively affects our life or the lives of others. Many of us may think this refers only to people who regularly use large amounts, but even a single occasion of use can lead to a problem. For instance, we may make a poor decision that results in problems with relationships or the law. What’s important to recognize is the potential for adverse consequences of use in any context and over time.
MDMA use, especially regular use, by young people has particular risks. Like other psychoactive drugs, MDMA can interfere with normal brain development. Early use can also interfere with developing normal patterns of social interaction with peers and have a negative impact on well-being.
One consequence that can develop is tolerance. This happens when it takes more of the drug to achieve the positive effects. While most people who use MDMA do not become dependent on the drug, those who use MDMA frequently over a period of time may begin to feel like they need the drug to function and feel normal.
The reasons people use MDMA influence their risk of developing problems. For instance, if a person uses MDMA to have fun, only occasional social use may follow. But when a person uses MDMA to cope with a long-term problem such as social anxiety, then more long-lasting and intense use may follow.
Mixing MDMA with other substances
People sometimes mix MDMA with other substances to experience different feelings or to offset the effects. For instance, a person may use a sleeping pill to help them relax and rest after using MDMA. But combining substances is risky as they can act in unexpected ways. The following are some common combinations and possible results.
Alcohol and other depressants
These are substances that slow down our heart and make us feel more relaxed. Depressants affect coordination and other skills needed for safe driving. Combining MDMA with depressants may cloud our judgment about how intoxicated we are, potentially leading to risky decisions such as driving a vehicle.
Stimulants
These are substances such as methamphetamine that increase our heart rate, breathing, thoughts and actions. Since MDMA is also a stimulant, using it with other drugs in the same category can intensify these effects and increase our chance of experiencing problems such as rapid heart rate and agitation.
Cannabis
Combining cannabis with MDMA may mask the effects of each drug. This may lessen our control over our behaviour, increasing the chances we may take risks that result in problems.
Medications
When prescription or over-the-counter medications are used with MDMA, there is the potential for negative side effects or for the medicinal benefits to cancel out. Taking the time to read medication labels or consulting with a healthcare professional can reduce these risks.
How to make healthier choices about MDMA
Whenever we choose to use MDMA, it is helpful to know what steps we can take to ensure that our use is the least harmful possible. Some of the risks of using MDMA involve not knowing for certain what is contained in a particular pill, capsule or powder. A testing kit can provide some information. For example, it may show the presence of MDMA. But this type of test gives no information about the amount. And some substances, including those with toxins, may go undetected. Laboratory tests, on the other hand, can provide more precise information about the presence and amount of a variety of substances.
Not too much. Managing the amount we use in a given period can help to decrease negative effects.
Tip: Buy less so you use less, and set a limit on how much you will use at one time.
Not too often. Limiting how much we use helps reduce harms to ourselves and others over time.
Tip: Think about when you are likely to use and then try to break the pattern by consciously planning other activities (e.g., spend time with a friend who doesn’t use, go to the gym).
Only in safe contexts. Making informed decisions about where and with whom we use MDMA helps to minimize harms.
Tip: If going out dancing, stay in the company of trusted friends, take breaks in a cool room and drink moderate amounts of water.
Legal status
MDMA is a controlled substance in Canada. It is illegal to make, sell, buy or use MDMA. Offenders may receive a fine, a prison term and a criminal record that could affect their future employment, travel plans and educational opportunities.
What to do if you or someone you know wants to explore change
To better understand how substances play a role in your life, visit the You and Substance Use Workbook on the Here to Help website: www.heretohelp.bc.ca. This website also features detailed information on substance use and mental health.
You can also find information about a wide variety of substance use issues on the Centre for Addictions Research of BC website: www.carbc.ca.
For information on treatment options and resources throughout BC, call the Alcohol and Drug Information and Referral Service at 1-800-663-1441. In Greater Vancouver, call 604-660-9382.
About the author
The Canadian Institute for Substance Use Research, formerly CARBC, is a member of the BC Partners for Mental Health and Substance Use Information. The institute is dedicated to the study of substance use in support of community-wide efforts aimed at providing all people with access to healthier lives, whether using substances or not. For more, visit www.cisur.ca.
Footnotes:
- 3,4- methylenedioxymethamphetamine
